SPILLOVER EFFECTS OF RESIDENTIAL SPATIAL SOCIAL POLARIZATION AND HIGH BLOOD PRESSURE AMONG VA NURSING HOME RESIDENTS

Abstract Spatial social polarization (SSP) – the process by which a population within an area diverges across socioeconomic characteristics– has been associated with hypertension. SSP indices measure the extent to which a population is distributed at extremes of privilege and deprivation. The VA nursing home represents an environment where spatially-oriented disparities are expected to be attenuated due to the fact that Veterans have equal access to care. We examined the association between SSP measured at residents’ home addresses prior to admission with blood pressure (BP) outcomes in the first four weeks after admission. We evaluated the use of the index of concentration (ICE) of extremes to measure SSP across four socioeconomic domains including race/ethnicity, income, home ownership, and joint race/ethnicity with income at the tract level using 2010 census data. SSP was dichotomized as the first (most polarized and disadvantaged) quintile vs. the 2nd -5th quintiles. The analytic sample included 41,972 long-term care residents aged ≥65 years admitted from 2006-2019. Multilevel mixed-effects regression models were adjusted for individual demographics and chronic conditions. We found Veterans who had resided in the most polarized and disadvantaged quintile (Q1) had a 1.10 (95% 1.01, 1.19) relative risk of high BP compared to those in Q 2-5 for the ICE jointly measuring race/ethnicity and income. We found similar results for systolic BP. In summary, SSP that jointly measures economic and racial/ethnic polarization, may have a spillover effect on health disparities even in a healthcare setting with equal access.

together a series of talks that address space (walkability, physical activity destinations) and place (racial and socioeconomic polarization) for falls and fear of falling (Pam Dunlap), physical activity behaviors (Pat Donahue), and blood pressure (Hoda Magid).The talks also advance methodology and conceptualization of space and place through use of novel exposure measurements (e.g., Google StreetView audits, spatial polarization) and more nuanced characterization of outcomes (e.g., considering risk stratification and various behavioral aspects of physical activity).Finally, we end with two talks demonstrating ways to advance methods, including the use of longitudinal data to understand long-term neighborhood exposures in relation to outcomes in older adults (Michael Desjardins) and incorporation of novel measures into existing cohorts (Jana Hirsch).These talks leverage data from a diverse range of studies including long-standing cohorts (CHS, MESA), an intervention trial, and VA nursing home data.Together, these talks further our understanding of how neighborhood environments relate to health at older ages and demonstrate the ways in which the field can advance our conceptualization of space and place as both barriers and promoters of health.Yvonne Michael will lead a discussion with the panel and audience on future directions and methodological needs for the field.
Abstract citation ID: igad104.0017Neighborhood built environment may influence both objective and perceived risk of falling.We examined the association between neighborhood built environmental characteristics and falls, fear of falling (FOF), and gait efficacy among older adults.We used baseline data from a randomized trial that measured falls over the past 12 months, FOF, and Modified Gait Efficacy Scale (mGES).Walkability audits were conducted for participant home addresses using Google StreetView and summarized by two factors: urbanicity and neighborhood quality.Logistic and linear regression were adjusted for age, gender, race, comorbidity index, and body mass index.Analyses were also stratified by past falls and gait speed (< or ≥1.0m/s).We included 249 participants (mean age: 77.4 years; 65% female) with 29.7% reporting a fall over the past year and 40.6% reporting FOF.Mean mGES (0-100) was 85.2±13.7 and 32% participants had gait speed <1.0m/s.In unstratified analysis, greater urbanicity was associated with lower gait efficacy (β=-1.88,p=.039).Among those who had not fallen, greater urbanicity was associated with FOF (β=0.47,p=.012) and greater urbanicity and higher neighborhood quality were associated with lower gait efficacy (β=-2.8,p=.006; β=-2.1, p=.047).Among those with better mobility, urbanicity was associated with lower gait efficacy and FOF (β=-2.4,p=.009; β=0.5, p=.01).There were no significant associations among those who had fallen or with poorer mobility.Neighborhood environmental characteristics may play a larger role in FOF among those who have better mobility and have not yet fallen, as they may have more opportunities to interact with varied environmental conditions.Neighborhood amenities may reduce barriers to engaging in physical activity (PA).However, it is unclear whether proximity to these amenities will indeed promote increased PA.This study examined whether living near PA destinations was associated with greater self-reported PA.The sample included Cardiovascular Health Study participants (N=3,922; mean age=75.3years) from visit 5 (1992)(1993).Quantity of PA destinations (e.g., gyms) within a one-kilometer Euclidean buffer of each participant's home address was provided by the National Establishment Time-Series database.PA over the previous two weeks was self-reported via the Minnesota Leisure Time Activity Questionnaire.The exposure was dichotomized into having at least one PA destination (vs.none) within one kilometer of participants' homes.Outcomes were based on the FITT components of PA outlined by the American College of Sports Medicine: Frequency (activities per week), Intensity (MET-minutes per week), Time (minutes per day), and Type (number of different activities, i.e., variety).Outcomes were modeled separately as five-level ordinal variables considering PA guidelines.Using ordinal logistic regression models adjusting for age, sex, health status, smoking, and body mass index, we found that living within one kilometer of at least one PA destination was associated with significantly increased odds of engaging in higher levels of all four PA components (odds ratios: 1.17-1.20,all Ps < 0.01).After adjusting for social factors (race, education, income), associations were attenuated and no longer significant.When evaluating barriers to PA, social determinants of health should be considered, in addition to proximity of PA destinations.

ASSOCIATION BETWEEN NEIGHBORHOOD ENVIRONMENT AND FEAR OF FALLING AND FALLS AMONG COMMUNITY-DWELLING OLDER ADULTS
Abstract citation ID: igad104.0019

SPILLOVER EFFECTS OF RESIDENTIAL SPATIAL SOCIAL POLARIZATION AND HIGH BLOOD PRESSURE AMONG VA NURSING HOME RESIDENTS Hoda Abdel Magid, and Michelle Odden, Stanford University, Stanford, California, United States
Spatial social polarization (SSP) -the process by which a population within an area diverges across socioeconomic characteristics-has been associated with hypertension.SSP indices measure the extent to which a population is distributed at extremes of privilege and deprivation.The VA nursing home represents an environment where spatially-oriented disparities are expected to be attenuated due to the fact that Veterans have equal access to care.We examined the association between SSP measured at residents' home addresses prior to admission with blood pressure (BP) outcomes in the first four weeks after admission.We evaluated the use of the index of concentration (ICE) of extremes to measure SSP across four socioeconomic domains including race/ethnicity, income, home ownership, and joint race/ethnicity with income at the tract level using 2010 census data.SSP was dichotomized as the first (most polarized and disadvantaged) quintile vs. the 2nd -5th quintiles.The analytic sample included 41,972 long-term care residents aged ≥65 years admitted from 2006-2019.Multilevel mixed-effects regression models were adjusted for individual demographics and chronic conditions.We found Veterans who had resided in the most polarized and disadvantaged quintile (Q1) had a 1.10 (95% 1.01, 1.19) relative risk of high BP compared to those in Q 2-5 for the ICE jointly measuring race/ethnicity and income.We found similar results for systolic BP.In summary, SSP that jointly measures economic and racial/ethnic polarization, may have a spillover effect on health disparities even in a healthcare setting with equal access.

IMPROVING LONGITUDINAL STUDIES OF AGING IN GEOSPATIAL HEALTH: AN AGENDA
Michael Desjardins 1 , Kyle Moored 1 , Emily Murray 2 , Gergő Baranyi 3 , Matthew Hobbs 4 , Sarah Curtis 5 , and Michelle Carlson 1 , 1. Johns Hopkins Bloomberg School  of Public Health, Baltimore, Maryland, United States, 2.  University College London, London, England, United  Kingdom, 3. University of Edinburgh, Edinburgh, Scotland,  United Kingdom, 4. University of Canterbury, Christchurch,  Canterbury, New Zealand, 5. Durham University, Durham,  England, United Kingdom  Recent decades have seen a vast demographic shift in ageing populations worldwide, where over 1.4 billion people will be aged 60 years and older by 2030.Given specific populations may be more vulnerable to medical conditions with ageing, identifying high-risk locations are essential for allocating resources and promoting healthy ageing to mitigate population-level financial-and health-associated burdens.All aspects of public health research on ageing require longitudinal analyses to fully capture the dynamics of outcomes and risk factors such as human mobility, climate change, non-communicable diseases, and endemic, emerging, and re-emerging infectious diseases.Incorporating geospatial approaches in longitudinal health research can facilitate targeted interventions and improve public health policy and decision-making.Furthermore, geospatial approaches can identify where at-risk populations are located and what influences disease risk and exposure, particularly the 'wider determinants' of health across the lifecourse.However, studies in geospatial health are often limited to spatial and temporal cross sections.This generates uncertainty in the timing of exposures and behaviors.Geospatial longitudinal studies can better capture spatiotemporal dynamics of ageing.Here, we outline a research agenda, including key challenges and opportunities of working with longitudinal geospatial health data.Examples include accounting for residential and human mobility, recruiting new birth cohorts, geoimputation, international and interdisciplinary collaborations, spatial lifecourse studies, and qualitative and mixed-methods approaches.As a proof of concept, we present several case studies that better capture longitudinal exposures for the Cardiovascular Health Study cohort, which previously incorporated erroneous spatial indicators of neighborhoodlevel exposures across baseline and follow-up measures.